Provider Demographics
NPI:1225137177
Name:MATTIA, ROBERT (LCMHC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:MATTIA
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 ISLAND POND RD
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-4144
Mailing Address - Country:US
Mailing Address - Phone:603-434-4335
Mailing Address - Fax:
Practice Address - Street 1:12 PARMENTER RD
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3280
Practice Address - Country:US
Practice Address - Phone:603-437-2069
Practice Address - Fax:603-437-5588
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional